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      Positive deviance for dual-method promotion among women in Uganda: study protocol for a cluster randomized controlled trial

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          Abstract

          Background

          Dual-method use is known as the most reliable protection against unintended pregnancies and sexually transmitted infections, including HIV. However, it is not commonly used in sub-Sharan Africa, especially among women using highly effective contraceptives. This article describes a protocol to evaluate the effect of an intervention formulated under the positive deviance approach for promoting dual-method use in Uganda.

          Methods

          A total of 150 women will be interviewed using a structured questionnaire to find those practicing dual-method use. In-depth interviews will then be conducted with all women using the dual method and 10 women using only highly effective contraceptives to identify their unique practice. Then, a cluster randomized controlled trial will be conducted to examine the effect of an intervention formulated under the positive deviance approach on dual-method uptake and adherence. Twenty health facilities will be randomized to an intervention or control arm and 480 women will be enrolled in each group. The participants will be followed up for 8 months.

          Discussion

          This trial focuses on women who already adapted dual-method use and identifies their unique solutions to promote dual-method use. This trial could tackle barriers for dual-method use, which expert outsiders may fail to recognize, by analyzing and promulgating their unique behaviors. This study could provide evidence that the positive deviance approach can address unintended pregnancies and sexually transmitted infections as well as other health problems which usual approaches have failed to address.

          Trial registration

          UMIN-CTR Clinical Trial, UMIN000037065. Registered on 14 June 2019.

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          Most cited references 35

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          HIV Infection and AIDS in Sub-Saharan Africa: Current Status, Challenges and Opportunities

          Global trends in HIV infection demonstrate an overall increase in HIV prevalence and substantial declines in AIDS related deaths largely attributable to the survival benefits of antiretroviral treatment. Sub-Saharan Africa carries a disproportionate burden of HIV, accounting for more than 70% of the global burden of infection. Success in HIV prevention in sub-Saharan Africa has the potential to impact on the global burden of HIV. Notwithstanding substantial progress in scaling up antiretroviral therapy (ART), sub-Saharan Africa accounted for 74% of the 1.5 million AIDS related deaths in 2013. Of the estimated 6000 new infections that occur globally each day, two out of three are in sub-Saharan Africa with young women continuing to bear a disproportionate burden. Adolescent girls and young women aged 15-24 years have up to eight fold higher rates of HIV infection compared to their male peers. There remains a gap in women initiated HIV prevention technologies especially for women who are unable to negotiate the current HIV prevention options of abstinence, behavior change, condoms and medical male circumcision or early treatment initiation in their relationships. The possibility of an AIDS free generation cannot be realized unless we are able to prevent HIV infection in young women. This review will focus on the epidemiology of HIV infection in sub-Saharan Africa, key drivers of the continued high incidence, mortality rates and priorities for altering current epidemic trajectory in the region. Strategies for optimizing the use of existing and increasingly limited resources are included.
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            The power of positive deviance.

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              Development and psychometric evaluation of the brief HIV Knowledge Questionnaire.

              This research evaluated the psychometric properties of a brief self-report measure of HIV-related knowledge, the 18-item HIV Knowledge Questionnaire (HIV-KQ-18). Low-income men and women (N = 1,019) responded to 27 items that represented the domain of interest. Item analyses indicated that 18 items, with item-total correlations ranging from .24 to .57, be retained. Additional analyses demonstrated the HIV-KQ-18's internal consistency across samples (alphas = .75-.89), test-retest stability across several intervals (rs = .76- .94), and strong associations with a much longer, previously validated measure (rs = .93-.97). Data from three clinical trials indicated that the HIV-KQ-18 detected knowledge gains in treated participants when compared to untreated controls. We conclude that the HIV-KQ-18 is internally consistent, stable, sensitive to the change resulting from intervention, and suitable for use with low-literacy populations.
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                Author and article information

                Contributors
                hodakos@m.u-tokyo.ac.jp
                shibanuma@m.u-tokyo.ac.jp
                jkiriya@m.u-tokyo.ac.jp
                kenicong@m.u-tokyo.ac.jp
                smucunguzi@yahoo.ca
                conradmuzoora@must.ac.ug
                mjimba@m.u-tokyo.ac.jp
                Journal
                Trials
                Trials
                Trials
                BioMed Central (London )
                1745-6215
                17 March 2020
                17 March 2020
                2020
                : 21
                Affiliations
                [1 ]GRID grid.26999.3d, ISNI 0000 0001 2151 536X, Department of Community and Global Health, School of International Health, Graduate School of Medicine, , The University of Tokyo, ; 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
                [2 ]GRID grid.33440.30, ISNI 0000 0001 0232 6272, Department of Community Health, , Mbarara University of Science and Technology, ; P.O BOX 1410, Mbarara, Uganda
                [3 ]GRID grid.33440.30, ISNI 0000 0001 0232 6272, Department of Internal Medicine, , Mbarara University of Science and Technology, ; P.O BOX 1410, Mbarara, Uganda
                Article
                4192
                10.1186/s13063-020-4192-8
                7077095
                32183908
                © The Author(s). 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100003168, Foundation for Advanced Studies on International Development;
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2020

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